What’s the Most Hair Loss Seen in Patients On Finasteride for Years?

Hello Drs. Rassman + Pak, thank you for creating this amazing website.

You recently posted regarding the (encouraging) 10 year Finasteride usage clinical results. And, I believe, you have stated that some NHI patients have used Finasteride for 10+ years and maintained their hair almost completely.

I was wondering about the flip side of the coin — what is the MOST hair loss you’ve seen among patients who have stayed on Finasteride?

I ask because I’m nervous about my own future (as a 28-year-old Norwood 3 on Finasteride who just had a transplant).

Thank you!

I am not sure how to quantify the most hair loss I’ve seen. When I meet with patients and examine their hair loss, I generally give them a Master Plan as to where their hair loss is going. So if an 18 year old male with a full head of hair comes for an examination and I see that they have almost all miniaturized hairs on the front and top in a Norwood 6 pattern, I can explain to them they may progress to a Norwood 6. I would then likely put them on Propecia and after a year they may grow some hair back, or at the least maintain what they have.

Over the following years, I suspect they would lose more and more hair, but at a much slower rate than if they were never on Propecia. Eventually, after 10 or 20 years, they would end up as a Norwood 6, but before this happens they may choose to have a hair transplant surgery to avoid looking bald. This is an example of what I mean by a Master Plan. I don’t immediate recommend surgery, but plan out how someone may lose hair and bald, which is why we come up with a road map to address their hair loss issues (with medication and surgery).

But to give you the short answer — I have seen someone still go bald, despite being on Propecia. Genetics will always win out and I can’t guarantee the medication works the same for everyone that takes it.